Patient

Partnered Adds partner wording Comfortable talking with partner

Labs

Include labs in the planShows lab tiles and interpretation

Ferritin

Ferritin range

History of heavy bleedingRaises the deficiency cutoff to 50 Heavy bleeding is currentAdds "get the bleeding under control" and the soaking-a-pad warning Iron plan Ask her iron history, and start ferrous sulfate 325 mg every other day if she isn't on it Start ferrous sulfate 325 mg every other day Already taking iron: continue, recheck in 3 months Iron is fine: no plan needed

Estradiol (pg/mL)

Testosterone (ng/dL)

Testosterone range

SHBG (nmol/L)

Testosterone plan (labs) Room to adjust: iron first, revisit in about 2 weeks Increase testosterone now In range: continue current dose Don't discuss testosterone in the labs section SHBG on the low sideAdds insulin note and A1c question

A1c (optional)

Other lab line (optional)

What she reported

Low desire / less initiatingUsed to feel satisfied, wants it back Takes longer to become aroused Orgasm harder than it used to be Orgasm has always been somewhat hard Responsive desire intactBody responds once started; intimacy feels worth it Avoiding intimacy; strain on relationship Mild dryness at most, no pain Pain with sex Urinary symptoms (urgency, frequency, waking to go, UTIs)Adds the GSM explanation Nothing switches on, even once things beginResponsive desire not intact Pressure or bulge sensationPossible prolapse → gynecology referral Body image, mood, or stress getting in the way

Contributors & plan

Antidepressant side effectCreates the prescriber letter GLP-1 medication Testosterone Vaginal estrogen Lubricant as needed Sex therapy / guided programMindfulness-based CBT "Take some pressure off intimacy" sectionCloseness without expectation Check thyroid function and prolactin Addyi / Vyleesi: revisit if not improving in 2–3 months

Other contributors

Perimenopause / menopause hormones Antihistamine useAdds to dryness Recently stopped birth control Uses clobetasolSkin check at the exam

Special situations

Blood pressure medication Regular opioid use Currently on hormonal birth control Breast cancer historyTurns off systemic hormone and testosterone suggestions Hysterectomy and/or oophorectomy Partner has sexual difficulties of their own The pressure comes mostly from her partner History of unwanted or painful sexual experiencesAdds a gentle trauma-informed paragraph Poor sleep or exhaustion is a brake

Already tried (changes the wording)

Testosterone Sex therapy or counseling Pelvic floor physical therapy

Other hormones she's on

Estradiol Progesterone

Questions for her

Each becomes an "I need to know" box in the plan and a reply item in the portal message.

Iron history: told it was low before? taking iron now? A1c or glucose checked in the last year? Did desire change around the time the GLP-1 started? How long on the antidepressant, and did the timing line up? Custom question (optional)

Custom section (optional)

Heading Text (use **bold**; blank line = new paragraph; lines starting with - become bullets)

Chart note only

Additional plan items (one per line; not shown to patient)

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